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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":5789.01,"10th_percentile":5789.01,"90th_percentile":5789.01,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":14744.73,"10th_percentile":14744.73,"90th_percentile":14744.73,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":19296.69,"10th_percentile":19296.69,"90th_percentile":19296.69,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2076.9,"10th_percentile":2076.9,"90th_percentile":2076.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2571.0,"10th_percentile":2571.0,"90th_percentile":2571.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17691.53,"10th_percentile":17691.53,"90th_percentile":17691.53,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9693.71,"10th_percentile":9693.71,"90th_percentile":9693.71,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4546.7,"10th_percentile":4546.7,"90th_percentile":4546.7,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":43552.78,"10th_percentile":43552.78,"90th_percentile":43552.78,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8163.3,"10th_percentile":8163.3,"90th_percentile":8163.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":13466.63,"10th_percentile":13466.63,"90th_percentile":13466.63},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":6216.18,"10th_percentile":6216.18,"90th_percentile":6216.18,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":11989.8,"10th_percentile":11989.8,"90th_percentile":11989.8,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2497.06,"10th_percentile":2497.06,"90th_percentile":5636.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":3139.12,"10th_percentile":3139.12,"90th_percentile":3139.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":15104.35,"10th_percentile":15104.35,"90th_percentile":15104.35,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":6356.46,"10th_percentile":6356.46,"90th_percentile":6356.46,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":3849.16,"10th_percentile":3661.06,"90th_percentile":10724.69,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11051.52,"10th_percentile":11051.52,"90th_percentile":11051.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12260.3,"10th_percentile":12260.3,"90th_percentile":14982.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":10603.6,"10th_percentile":10603.6,"90th_percentile":10603.6,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6458.89,"10th_percentile":4717.4,"90th_percentile":9119.6,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4344.12,"10th_percentile":4344.12,"90th_percentile":4344.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":2571.9,"10th_percentile":2571.9,"90th_percentile":2571.9,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2497.06,"10th_percentile":2497.06,"90th_percentile":2497.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":11853.13,"10th_percentile":11853.13,"90th_percentile":11853.13,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12377.4,"10th_percentile":12377.4,"90th_percentile":12377.4,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":11434.61,"10th_percentile":11434.61,"90th_percentile":11434.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":4900.94,"10th_percentile":4900.94,"90th_percentile":4900.94,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7571.37,"10th_percentile":4258.88,"90th_percentile":12275.49,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8217.6,"10th_percentile":6306.18,"90th_percentile":12759.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":38471.18,"10th_percentile":38471.18,"90th_percentile":38471.18,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":27460.45,"10th_percentile":27460.45,"90th_percentile":27460.45,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17721.45,"10th_percentile":17721.45,"90th_percentile":17721.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":6594.13,"10th_percentile":6594.13,"90th_percentile":6594.13,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2482.96,"10th_percentile":2482.96,"90th_percentile":5142.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"1 through 10","median_amount":15676.67,"10th_percentile":15676.67,"90th_percentile":15676.67,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":9701.28,"10th_percentile":7491.18,"90th_percentile":12275.49,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2446.89,"10th_percentile":2446.89,"90th_percentile":2446.89,"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":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":5704.81,"10th_percentile":5704.81,"90th_percentile":5704.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10141.16,"10th_percentile":10141.16,"90th_percentile":10141.16,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":908.47,"10th_percentile":908.47,"90th_percentile":908.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4354.92,"10th_percentile":4354.92,"90th_percentile":4354.92,"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":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12855.0,"10th_percentile":12855.0,"90th_percentile":12855.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":16864.8,"10th_percentile":16864.8,"90th_percentile":16864.8,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14010.65,"10th_percentile":14010.65,"90th_percentile":14010.65,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8729.44,"10th_percentile":4305.92,"90th_percentile":16913.71,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13024.98,"10th_percentile":13024.98,"90th_percentile":13024.98,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7491.17,"10th_percentile":3384.12,"90th_percentile":12252.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":7715.7,"10th_percentile":7715.7,"90th_percentile":7715.7,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6567.0,"10th_percentile":6567.0,"90th_percentile":6567.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7845.84,"10th_percentile":7845.84,"90th_percentile":7845.84,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":9113.32,"10th_percentile":9113.32,"90th_percentile":9113.32},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":2500.0,"10th_percentile":2500.0,"90th_percentile":2500.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17152.23,"10th_percentile":17152.23,"90th_percentile":17152.23,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":12085.85,"10th_percentile":12085.85,"90th_percentile":12085.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7350.96,"10th_percentile":7350.96,"90th_percentile":7350.96,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":5881.18,"10th_percentile":5881.18,"90th_percentile":5881.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14900.88,"10th_percentile":14900.88,"90th_percentile":14900.88,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":4783.67,"10th_percentile":4783.67,"90th_percentile":4783.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2497.06,"10th_percentile":2497.06,"90th_percentile":2497.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":17223.69,"10th_percentile":17223.69,"90th_percentile":17223.69,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":7145.92,"10th_percentile":7145.92,"90th_percentile":7145.92,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":9009.73,"10th_percentile":9009.73,"90th_percentile":9009.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2455.1,"10th_percentile":2455.1,"90th_percentile":2455.1,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":22473.54,"10th_percentile":22473.54,"90th_percentile":22473.54,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":9820.4,"10th_percentile":9820.4,"90th_percentile":9820.4,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1099.52,"10th_percentile":1099.52,"90th_percentile":1099.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6458.89,"10th_percentile":6458.89,"90th_percentile":6458.89,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8088.24,"10th_percentile":8088.24,"90th_percentile":8088.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":6706.7,"10th_percentile":6706.7,"90th_percentile":6706.7,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":7763.12,"10th_percentile":7763.12,"90th_percentile":7763.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4900.63,"10th_percentile":4900.63,"90th_percentile":4900.63,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":3139.12,"10th_percentile":3139.12,"90th_percentile":3139.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2152.96,"10th_percentile":2152.96,"90th_percentile":2152.96,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8931.69,"10th_percentile":8931.69,"90th_percentile":8931.69,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4994.12,"10th_percentile":4994.12,"90th_percentile":4994.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13006.76,"10th_percentile":13006.76,"90th_percentile":13006.76,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":19194.54,"10th_percentile":19194.54,"90th_percentile":19194.54,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"1 through 10","median_amount":24842.72,"10th_percentile":24842.72,"90th_percentile":24842.72},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4462.72,"10th_percentile":4462.72,"90th_percentile":4462.72,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":3865.22,"10th_percentile":3865.22,"90th_percentile":3865.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":14262.76,"10th_percentile":14262.76,"90th_percentile":14262.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10005.54,"10th_percentile":10005.54,"90th_percentile":10005.54,"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 - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12646.9,"10th_percentile":12646.9,"90th_percentile":12646.9,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":5045.92,"10th_percentile":5045.92,"90th_percentile":5045.92,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14032.63,"10th_percentile":14032.63,"90th_percentile":14032.63,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":15122.78,"10th_percentile":15122.78,"90th_percentile":15122.78,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":19976.48,"10th_percentile":19976.48,"90th_percentile":19976.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":13893.88,"10th_percentile":13893.88,"90th_percentile":13893.88,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12541.42,"10th_percentile":12541.42,"90th_percentile":16032.23,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":25592.66,"10th_percentile":25592.66,"90th_percentile":25592.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8709.85,"10th_percentile":8709.85,"90th_percentile":8709.85,"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."}]}]},{"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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14606.96,"10th_percentile":14606.96,"90th_percentile":14606.96,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7350.95,"10th_percentile":7350.95,"90th_percentile":7350.95,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":12275.5,"10th_percentile":12275.5,"90th_percentile":12275.5,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":36633.14,"10th_percentile":36633.14,"90th_percentile":36633.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":10094.3,"10th_percentile":10094.3,"90th_percentile":10094.3,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4962.96,"10th_percentile":4962.96,"90th_percentile":4962.96,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":23268.35,"10th_percentile":23268.35,"90th_percentile":23268.35,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7491.18,"10th_percentile":7491.18,"90th_percentile":7491.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":18105.7,"10th_percentile":18105.7,"90th_percentile":18105.7,"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":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":33344.82,"10th_percentile":33344.82,"90th_percentile":33344.82,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":6431.46,"10th_percentile":6431.46,"90th_percentile":6431.46,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2056.1,"10th_percentile":2056.1,"90th_percentile":2056.1,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8378.24,"10th_percentile":8378.24,"90th_percentile":8378.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":10829.93,"10th_percentile":10829.93,"90th_percentile":10829.93,"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":"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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2046.9,"10th_percentile":2046.9,"90th_percentile":2046.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":15141.98,"10th_percentile":15141.98,"90th_percentile":15141.98,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":15752.4,"10th_percentile":15752.4,"90th_percentile":15752.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":2571.9,"10th_percentile":2571.9,"90th_percentile":2571.9,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":18171.48,"10th_percentile":18171.48,"90th_percentile":18171.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":38089.85,"10th_percentile":38089.85,"90th_percentile":38089.85,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":28945.04,"10th_percentile":28945.04,"90th_percentile":30874.7,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":13783.35,"10th_percentile":13783.35,"90th_percentile":13783.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7718.68,"10th_percentile":7718.68,"90th_percentile":7718.68,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10528.87,"10th_percentile":10528.87,"90th_percentile":10528.87,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8851.0,"10th_percentile":8851.0,"90th_percentile":8851.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":13417.36,"10th_percentile":13417.36,"90th_percentile":13417.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":10083.72,"10th_percentile":10083.72,"90th_percentile":10083.72,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":5285.75,"10th_percentile":5285.75,"90th_percentile":5285.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":13783.35,"10th_percentile":13783.35,"90th_percentile":13783.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":5334.99,"10th_percentile":5334.99,"90th_percentile":5334.99,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7561.39,"10th_percentile":7561.39,"90th_percentile":12275.51,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4994.12,"10th_percentile":4384.12,"90th_percentile":13257.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":33504.59,"10th_percentile":33504.59,"90th_percentile":33504.59,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":17977.33,"10th_percentile":17977.33,"90th_percentile":17977.33,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":18582.06,"10th_percentile":18582.06,"90th_percentile":18582.06,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14654.84,"10th_percentile":14654.84,"90th_percentile":14654.84,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":20325.5,"10th_percentile":20325.5,"90th_percentile":20325.5},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":9988.24,"10th_percentile":9988.24,"90th_percentile":9988.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":7667.65,"10th_percentile":3751.71,"90th_percentile":12355.67},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":26063.95,"10th_percentile":26063.95,"90th_percentile":26063.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7561.39,"10th_percentile":7561.39,"90th_percentile":7561.39,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8004.62,"10th_percentile":8004.62,"90th_percentile":8004.62,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":9629.23,"10th_percentile":8967.56,"90th_percentile":14736.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6080.8,"10th_percentile":6080.8,"90th_percentile":6080.8,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14852.88,"10th_percentile":14852.88,"90th_percentile":14852.88,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14712.85,"10th_percentile":14712.85,"90th_percentile":14712.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":335.0,"10th_percentile":335.0,"90th_percentile":335.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4994.12,"10th_percentile":4994.12,"90th_percentile":4994.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4965.92,"10th_percentile":4965.92,"90th_percentile":4965.92,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":3593.56,"10th_percentile":3593.56,"90th_percentile":3593.56},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8135.68,"10th_percentile":8135.68,"90th_percentile":8135.68,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":7898.72,"10th_percentile":7898.72,"90th_percentile":7898.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":3384.12,"10th_percentile":3384.12,"90th_percentile":3384.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":19950.89,"10th_percentile":19950.89,"90th_percentile":19950.89,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":7491.18,"10th_percentile":7491.18,"90th_percentile":7491.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":14951.34,"10th_percentile":14951.34,"90th_percentile":14951.34,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":16901.51,"10th_percentile":16901.51,"90th_percentile":16901.51,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6458.89,"10th_percentile":6458.89,"90th_percentile":6458.89,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8971.89,"10th_percentile":8971.89,"90th_percentile":8971.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"1 through 10","median_amount":4202.99,"10th_percentile":4202.99,"90th_percentile":4202.99},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":15164.05,"10th_percentile":15164.05,"90th_percentile":15164.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8261.93,"10th_percentile":8261.93,"90th_percentile":8261.93,"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":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":5085.53,"10th_percentile":5085.53,"90th_percentile":5085.53,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":18909.3,"10th_percentile":17177.7,"90th_percentile":33718.47,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6751.53,"10th_percentile":6751.53,"90th_percentile":6751.53,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":9807.3,"10th_percentile":9807.3,"90th_percentile":9807.3,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":14982.36,"10th_percentile":14982.36,"90th_percentile":14982.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":7715.7,"10th_percentile":7715.7,"90th_percentile":7715.7,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":4502.24,"10th_percentile":4502.24,"90th_percentile":4502.24,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11333.31,"10th_percentile":11333.31,"90th_percentile":11333.31,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":7715.7,"10th_percentile":7715.7,"90th_percentile":7715.7,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4994.12,"10th_percentile":4994.12,"90th_percentile":4994.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":19976.48,"10th_percentile":19976.48,"90th_percentile":19976.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":11706.83,"10th_percentile":11706.83,"90th_percentile":11706.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":17327.37,"10th_percentile":17327.37,"90th_percentile":17327.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":25115.43,"10th_percentile":25115.43,"90th_percentile":25115.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":30268.42,"10th_percentile":30268.42,"90th_percentile":30268.42,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":18655.96,"10th_percentile":18518.69,"90th_percentile":18655.96,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":23206.77,"10th_percentile":23206.77,"90th_percentile":23206.77},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":11768.76,"10th_percentile":7718.68,"90th_percentile":22858.5,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":18970.67,"10th_percentile":18970.67,"90th_percentile":18970.67,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8608.24,"10th_percentile":6230.7,"90th_percentile":18316.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":14560.53,"10th_percentile":14560.53,"90th_percentile":18003.3,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6532.39,"10th_percentile":6532.39,"90th_percentile":6532.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"1 through 10","median_amount":14537.93,"10th_percentile":14537.93,"90th_percentile":28417.66,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2571.0,"10th_percentile":2571.0,"90th_percentile":2571.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":8681.14,"10th_percentile":8681.14,"90th_percentile":8681.14,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":17479.42,"10th_percentile":17479.42,"90th_percentile":17479.42,"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":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6168.3,"10th_percentile":6168.3,"90th_percentile":6168.3,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":1984.25,"10th_percentile":1984.25,"90th_percentile":1984.25},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9150.92,"10th_percentile":9150.92,"90th_percentile":9150.92,"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 - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17721.45,"10th_percentile":17721.45,"90th_percentile":17721.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":3177.16,"10th_percentile":3177.16,"90th_percentile":3177.16,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":28539.72,"10th_percentile":28539.72,"90th_percentile":28539.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4906.63,"10th_percentile":4906.63,"90th_percentile":4914.63,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8307.6,"10th_percentile":8307.6,"90th_percentile":8307.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1809.17,"10th_percentile":1809.17,"90th_percentile":1809.17,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"1 through 10","median_amount":15438.92,"10th_percentile":15438.92,"90th_percentile":15438.92},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":3049.52,"10th_percentile":3049.52,"90th_percentile":3049.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3582.52,"10th_percentile":3582.52,"90th_percentile":3582.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4994.12,"10th_percentile":4994.12,"90th_percentile":4994.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":13834.6,"10th_percentile":13834.6,"90th_percentile":13834.6,"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 - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":2121.89,"10th_percentile":2121.89,"90th_percentile":2121.89,"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":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":8625.67,"10th_percentile":8625.67,"90th_percentile":8625.67,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":28020.86,"10th_percentile":28020.86,"90th_percentile":28020.86,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":9848.42,"10th_percentile":9848.42,"90th_percentile":9848.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":31383.35,"10th_percentile":31383.35,"90th_percentile":31383.35,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17721.45,"10th_percentile":17721.45,"90th_percentile":17721.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":11578.01,"10th_percentile":11578.01,"90th_percentile":23156.03,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"1 through 10","median_amount":4393.1,"10th_percentile":4393.1,"90th_percentile":4393.1},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":17721.45,"10th_percentile":15752.4,"90th_percentile":26893.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"1 through 10","median_amount":50037.25,"10th_percentile":50037.25,"90th_percentile":50037.25,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":52956.23,"10th_percentile":52956.23,"90th_percentile":52956.23,"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":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":39178.65,"10th_percentile":39178.65,"90th_percentile":39178.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":4112.2,"10th_percentile":4112.2,"90th_percentile":4112.2,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"1 through 10","median_amount":6388.33,"10th_percentile":6388.33,"90th_percentile":6388.33,"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":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Alcohol/ Chemical Dependency-Per Diem: 971] [Psych-Per Diem: 971] [All Other IP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":39.5,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Psych-Per Diem: 823.98] [Rehab-Per Diem: 526.87]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":61.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 6823.25] [Surgical-Per Diem: 6823.25] [Swing Bed-Per Diem: 5309.95]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":59.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Medical-Per Diem: 2497.06] [Surgical-Per Diem: 2497.06] [Swing Bed-Per Diem: 1592.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Medical-Per Diem: 2571.90] [Surgical-Per Diem: 2571.90] [Swing Bed-Per Diem: 2001.49]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":9614.13,"10th_percentile":9614.13,"90th_percentile":9614.13,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":11655.43,"10th_percentile":11655.43,"90th_percentile":11655.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"36","median_amount":118.56,"10th_percentile":38.56,"90th_percentile":324.58,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"229","median_amount":191.5,"10th_percentile":132.56,"90th_percentile":321.23},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"18","median_amount":38.02,"10th_percentile":36.2,"90th_percentile":43.15,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":63.99,"10th_percentile":63.99,"90th_percentile":63.99},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"42","median_amount":81.76,"10th_percentile":54.26,"90th_percentile":144.48,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"35","median_amount":197.63,"10th_percentile":45.0,"90th_percentile":627.34,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"114","median_amount":193.55,"10th_percentile":133.97,"90th_percentile":386.34},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"24","median_amount":34.28,"10th_percentile":31.31,"90th_percentile":35.31,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":19.65,"10th_percentile":11.61,"90th_percentile":416.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"26","median_amount":243.71,"10th_percentile":108.49,"90th_percentile":452.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"897","median_amount":199.38,"10th_percentile":137.85,"90th_percentile":345.22},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":111.72,"10th_percentile":111.72,"90th_percentile":237.01},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":34.28,"10th_percentile":34.28,"90th_percentile":34.28,"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":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"56","median_amount":33.3,"10th_percentile":29.3,"90th_percentile":155.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"31","median_amount":106.4,"10th_percentile":83.54,"90th_percentile":133.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"640","median_amount":99.32,"10th_percentile":70.2,"90th_percentile":261.07},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"15","median_amount":122.71,"10th_percentile":36.48,"90th_percentile":210.75,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":34.14,"10th_percentile":34.14,"90th_percentile":35.13,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"48","median_amount":192.32,"10th_percentile":153.29,"90th_percentile":332.05}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":209.06,"10th_percentile":209.06,"90th_percentile":209.06,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":64.32,"10th_percentile":64.32,"90th_percentile":64.32},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":63.83,"10th_percentile":63.83,"90th_percentile":63.83,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":65.55,"10th_percentile":65.55,"90th_percentile":65.55},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"14","median_amount":16.52,"10th_percentile":16.52,"90th_percentile":21.36,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"18","median_amount":166.33,"10th_percentile":133.06,"90th_percentile":291.08,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":62.25,"10th_percentile":59.29,"90th_percentile":62.25,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":138.57,"10th_percentile":138.57,"90th_percentile":138.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":64.32,"10th_percentile":64.32,"90th_percentile":64.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":64.32,"10th_percentile":64.32,"90th_percentile":83.4},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":118.02,"10th_percentile":118.02,"90th_percentile":118.02,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":57.55,"10th_percentile":57.55,"90th_percentile":64.32},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":64.32,"10th_percentile":64.32,"90th_percentile":64.32,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":61.95,"10th_percentile":57.33,"90th_percentile":118.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"23","median_amount":348.32,"10th_percentile":38.66,"90th_percentile":1046.66,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"12","median_amount":141.65,"10th_percentile":107.18,"90th_percentile":181.56},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"29","median_amount":111.68,"10th_percentile":108.51,"90th_percentile":323.48,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":117.98,"10th_percentile":65.55,"90th_percentile":273.09},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"33","median_amount":32.14,"10th_percentile":29.57,"90th_percentile":32.14,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"51","median_amount":290.99,"10th_percentile":78.4,"90th_percentile":672.52,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":113.79,"10th_percentile":58.2,"90th_percentile":609.49},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"41","median_amount":103.72,"10th_percentile":100.7,"90th_percentile":111.09,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":242.49,"10th_percentile":242.42,"90th_percentile":242.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":517.97,"10th_percentile":517.97,"90th_percentile":517.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"26","median_amount":115.99,"10th_percentile":5.99,"90th_percentile":190.13},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":22.58,"10th_percentile":22.58,"90th_percentile":22.58},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"14","median_amount":446.57,"10th_percentile":32.14,"90th_percentile":740.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"27","median_amount":116.11,"10th_percentile":6.11,"90th_percentile":121.91},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":107.18,"10th_percentile":107.18,"90th_percentile":112.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"17","median_amount":103.22,"10th_percentile":100.29,"90th_percentile":206.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":105.93,"10th_percentile":105.93,"90th_percentile":105.93}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"58","median_amount":875.99,"10th_percentile":183.53,"90th_percentile":1384.28,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"37","median_amount":358.12,"10th_percentile":248.46,"90th_percentile":588.37},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"113","median_amount":378.63,"10th_percentile":292.11,"90th_percentile":600.4,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"33","median_amount":251.25,"10th_percentile":65.55,"90th_percentile":394.25},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"168","median_amount":76.05,"10th_percentile":49.81,"90th_percentile":380.87,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"194","median_amount":781.79,"10th_percentile":276.58,"90th_percentile":1289.37,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"24","median_amount":344.02,"10th_percentile":288.43,"90th_percentile":490.93},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"129","median_amount":357.98,"10th_percentile":269.57,"90th_percentile":602.56,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"24","median_amount":661.37,"10th_percentile":322.16,"90th_percentile":1240.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":361.67,"10th_percentile":361.67,"90th_percentile":361.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"119","median_amount":315.99,"10th_percentile":123.98,"90th_percentile":508.47},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":715.56,"10th_percentile":715.56,"90th_percentile":715.56},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"1 through 10","median_amount":1001.73,"10th_percentile":1001.73,"90th_percentile":1026.06},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"52","median_amount":1057.92,"10th_percentile":300.0,"90th_percentile":1492.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"101","median_amount":327.59,"10th_percentile":193.71,"90th_percentile":479.24},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"29","median_amount":378.7,"10th_percentile":285.36,"90th_percentile":601.66,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"83","median_amount":370.53,"10th_percentile":283.5,"90th_percentile":554.88,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"16","median_amount":318.13,"10th_percentile":232.12,"90th_percentile":451.66}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"97","median_amount":2089.66,"10th_percentile":578.29,"90th_percentile":5423.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"20","median_amount":488.31,"10th_percentile":110.79,"90th_percentile":3385.59},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"117","median_amount":252.13,"10th_percentile":139.15,"90th_percentile":806.91,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"344","median_amount":1933.78,"10th_percentile":647.67,"90th_percentile":4424.64,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"65","median_amount":1037.03,"10th_percentile":625.21,"90th_percentile":2118.12},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"96","median_amount":789.49,"10th_percentile":505.45,"90th_percentile":1277.68,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"38","median_amount":1975.15,"10th_percentile":833.77,"90th_percentile":4157.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"14","median_amount":748.21,"10th_percentile":444.49,"90th_percentile":1796.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"215","median_amount":908.39,"10th_percentile":394.54,"90th_percentile":1964.19},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":2101.28,"10th_percentile":2101.28,"90th_percentile":3734.24},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"1 through 10","median_amount":4845.72,"10th_percentile":4845.72,"90th_percentile":4845.72},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"73","median_amount":1699.6,"10th_percentile":515.44,"90th_percentile":3526.65,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"206","median_amount":835.89,"10th_percentile":505.34,"90th_percentile":1927.95},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"63","median_amount":803.68,"10th_percentile":504.06,"90th_percentile":1545.07,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"61","median_amount":983.75,"10th_percentile":600.42,"90th_percentile":1812.13,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"16","median_amount":995.98,"10th_percentile":594.2,"90th_percentile":1894.33}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"104","median_amount":3845.29,"10th_percentile":1167.38,"90th_percentile":8634.63,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"97","median_amount":1920.69,"10th_percentile":946.79,"90th_percentile":3593.9},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"57","median_amount":2057.02,"10th_percentile":788.02,"90th_percentile":3509.99,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"13","median_amount":1094.68,"10th_percentile":452.52,"90th_percentile":4087.83},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"101","median_amount":550.54,"10th_percentile":238.46,"90th_percentile":1649.49,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"217","median_amount":3454.68,"10th_percentile":792.49,"90th_percentile":8594.4,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"47","median_amount":1573.28,"10th_percentile":569.8,"90th_percentile":3458.01},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"64","median_amount":2101.56,"10th_percentile":809.85,"90th_percentile":3511.2,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"38","median_amount":3456.82,"10th_percentile":1051.53,"90th_percentile":7292.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"12","median_amount":1764.55,"10th_percentile":918.48,"90th_percentile":3612.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"338","median_amount":1804.17,"10th_percentile":717.55,"90th_percentile":3588.54},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":4447.84,"10th_percentile":3570.48,"90th_percentile":5424.94},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":4485.25,"10th_percentile":4485.25,"90th_percentile":4485.25},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"1 through 10","median_amount":384.78,"10th_percentile":384.78,"90th_percentile":384.78},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"68","median_amount":2716.19,"10th_percentile":899.08,"90th_percentile":8015.87,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"299","median_amount":2099.94,"10th_percentile":941.51,"90th_percentile":3476.67},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"58","median_amount":1949.35,"10th_percentile":1057.71,"90th_percentile":3526.34,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"55","median_amount":1239.7,"10th_percentile":692.54,"90th_percentile":2823.59,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"19","median_amount":1409.79,"10th_percentile":746.79,"90th_percentile":4730.12}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":5286.38,"10th_percentile":3433.74,"90th_percentile":39658.22,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"16","median_amount":2591.02,"10th_percentile":2045.62,"90th_percentile":4502.98},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2604.02,"10th_percentile":1763.49,"90th_percentile":4155.23,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":10968.81,"10th_percentile":10968.81,"90th_percentile":15745.13},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":523.48,"10th_percentile":321.11,"90th_percentile":1452.65,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"26","median_amount":4569.89,"10th_percentile":2725.07,"90th_percentile":13124.88,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2908.56,"10th_percentile":2301.84,"90th_percentile":4545.17},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":2178.66,"10th_percentile":1555.97,"90th_percentile":5218.07,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3452.99,"10th_percentile":3452.99,"90th_percentile":3452.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"72","median_amount":3271.18,"10th_percentile":2003.32,"90th_percentile":5564.53},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":3839.32,"10th_percentile":2068.85,"90th_percentile":7383.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":9588.07,"10th_percentile":3254.92,"90th_percentile":13399.7,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"61","median_amount":3115.59,"10th_percentile":1875.83,"90th_percentile":5019.58},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":2820.16,"10th_percentile":2098.69,"90th_percentile":5573.8,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2413.34,"10th_percentile":2089.38,"90th_percentile":4332.37,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3728.56,"10th_percentile":3226.4,"90th_percentile":4184.48}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2300.75,"10th_percentile":2183.4,"90th_percentile":2485.5,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":826.93,"10th_percentile":826.93,"90th_percentile":826.93},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":933.25,"10th_percentile":850.73,"90th_percentile":988.31,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":1577.8,"10th_percentile":1577.8,"90th_percentile":1577.8},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":210.97,"10th_percentile":210.97,"90th_percentile":210.97,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":2177.23,"10th_percentile":194.55,"90th_percentile":3475.81,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1058.64,"10th_percentile":1058.64,"90th_percentile":1058.64},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2417.91,"10th_percentile":2417.91,"90th_percentile":2417.91,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":963.81,"10th_percentile":858.96,"90th_percentile":1755.69},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":832.42,"10th_percentile":832.42,"90th_percentile":832.42,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":462.45,"10th_percentile":462.45,"90th_percentile":462.45}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":328.56,"10th_percentile":328.56,"90th_percentile":328.56,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":760.05,"10th_percentile":760.05,"90th_percentile":760.05},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1426.39,"10th_percentile":1426.39,"90th_percentile":1426.39,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":501.6,"10th_percentile":501.6,"90th_percentile":501.6,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":1291.63,"10th_percentile":774.91,"90th_percentile":2920.91,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":1663.89,"10th_percentile":1663.89,"90th_percentile":1663.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":608.9,"10th_percentile":608.9,"90th_percentile":852.5},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2231.73,"10th_percentile":2231.73,"90th_percentile":2231.73,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":775.62,"10th_percentile":661.98,"90th_percentile":2649.28},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":554.33,"10th_percentile":554.33,"90th_percentile":554.33,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":4333.23,"10th_percentile":4333.23,"90th_percentile":4333.23,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":1470.72,"10th_percentile":1470.72,"90th_percentile":1470.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2833.11,"10th_percentile":2833.11,"90th_percentile":2833.11},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":3017.49,"10th_percentile":3017.49,"90th_percentile":3017.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":649.61,"10th_percentile":649.61,"90th_percentile":649.61,"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":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":6350.38,"10th_percentile":6350.38,"90th_percentile":6350.38,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1950.78,"10th_percentile":1950.78,"90th_percentile":1950.78,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":147.89,"10th_percentile":147.89,"90th_percentile":147.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":5909.97,"10th_percentile":5909.97,"90th_percentile":5909.97,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":486.95,"10th_percentile":486.95,"90th_percentile":486.95},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":763.01,"10th_percentile":763.01,"90th_percentile":763.01,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":819.09,"10th_percentile":819.09,"90th_percentile":819.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":571.95,"10th_percentile":351.86,"90th_percentile":1403.48},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1586.84,"10th_percentile":1586.84,"90th_percentile":1586.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":253.81,"10th_percentile":253.81,"90th_percentile":253.81,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":4293.29,"10th_percentile":4293.29,"90th_percentile":4293.29,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1304.76,"10th_percentile":1240.31,"90th_percentile":1412.57},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1930.46,"10th_percentile":1930.46,"90th_percentile":1930.46,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":346.31,"10th_percentile":346.31,"90th_percentile":346.31,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"12","median_amount":2729.87,"10th_percentile":1974.03,"90th_percentile":3802.54,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2027.64,"10th_percentile":2027.64,"90th_percentile":4224.22},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1072.46,"10th_percentile":1072.46,"90th_percentile":1072.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2419.97,"10th_percentile":1150.5,"90th_percentile":5215.65},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1956.23,"10th_percentile":1956.23,"90th_percentile":6869.87,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":4370.96,"10th_percentile":4370.96,"90th_percentile":8616.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2190.77,"10th_percentile":878.67,"90th_percentile":3772.14},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":1691.88,"10th_percentile":1691.88,"90th_percentile":1691.88,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":9607.6,"10th_percentile":9607.6,"90th_percentile":9607.6,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3925.18,"10th_percentile":3925.18,"90th_percentile":7110.64,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2794.87,"10th_percentile":2794.87,"90th_percentile":2794.87},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":3251.5,"10th_percentile":3251.5,"90th_percentile":3251.5,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":3380.13,"10th_percentile":3380.13,"90th_percentile":3380.13,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":2427.79,"10th_percentile":2427.79,"90th_percentile":2427.79,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":70.78,"10th_percentile":70.78,"90th_percentile":70.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3485.87,"10th_percentile":3485.87,"90th_percentile":3485.87},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2581.54,"10th_percentile":2581.54,"90th_percentile":2581.54},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":2156.88,"10th_percentile":2156.88,"90th_percentile":2156.88,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1885.69,"10th_percentile":1885.69,"90th_percentile":1885.69}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":4530.31,"10th_percentile":4530.31,"90th_percentile":4530.31,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2460.82,"10th_percentile":2460.82,"90th_percentile":2460.82},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":5413.6,"10th_percentile":4688.2,"90th_percentile":10893.64,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2383.78,"10th_percentile":2383.78,"90th_percentile":2383.78},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1087.84,"10th_percentile":1087.84,"90th_percentile":1087.84,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2199.16,"10th_percentile":2199.16,"90th_percentile":2199.16},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":2596.92,"10th_percentile":2596.92,"90th_percentile":2596.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1413.63,"10th_percentile":1413.63,"90th_percentile":1413.63},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1763.73,"10th_percentile":1763.73,"90th_percentile":1763.73,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2028.72,"10th_percentile":2028.72,"90th_percentile":2028.72}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":11309.55,"10th_percentile":11309.55,"90th_percentile":11957.54,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":31268.9,"10th_percentile":31268.9,"90th_percentile":31268.9,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2932.78,"10th_percentile":2932.78,"90th_percentile":2932.78},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":39.07,"10th_percentile":39.07,"90th_percentile":39.07,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4443.22,"10th_percentile":4443.22,"90th_percentile":4443.22},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":4808.21,"10th_percentile":4808.21,"90th_percentile":4808.21,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4773.71,"10th_percentile":4307.88,"90th_percentile":6567.66},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":53914.13,"10th_percentile":53914.13,"90th_percentile":53914.13,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":10146.17,"10th_percentile":10146.17,"90th_percentile":19401.02},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":18217.39,"10th_percentile":18217.39,"90th_percentile":18217.39,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":35154.78,"10th_percentile":34883.92,"90th_percentile":41074.08,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":14679.87,"10th_percentile":14679.87,"90th_percentile":14679.87},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":16979.32,"10th_percentile":16262.17,"90th_percentile":18709.64},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"1 through 10","median_amount":44042.09,"10th_percentile":44042.09,"90th_percentile":44042.09},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":15494.72,"10th_percentile":15494.72,"90th_percentile":15494.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":38648.54,"10th_percentile":38648.54,"90th_percentile":39978.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":16430.19,"10th_percentile":16230.04,"90th_percentile":16607.88},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":15101.53,"10th_percentile":15101.53,"90th_percentile":15101.53,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11542.48,"10th_percentile":11542.48,"90th_percentile":11542.48,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":96662.71,"10th_percentile":96662.71,"90th_percentile":120372.93,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":31860.08,"10th_percentile":382.0,"90th_percentile":35935.93},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"14","median_amount":73743.53,"10th_percentile":32024.52,"90th_percentile":90543.33,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":38308.32,"10th_percentile":36256.22,"90th_percentile":42624.05},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":28083.91,"10th_percentile":28083.91,"90th_percentile":28083.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"23","median_amount":32496.45,"10th_percentile":25731.3,"90th_percentile":39340.25},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":30059.04,"10th_percentile":30059.04,"90th_percentile":34651.33,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":90757.5,"10th_percentile":90757.5,"90th_percentile":95342.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":31258.25,"10th_percentile":29897.79,"90th_percentile":43866.59},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":28657.83,"10th_percentile":28657.83,"90th_percentile":28657.83,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":4089.45,"10th_percentile":4089.45,"90th_percentile":4089.45,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3415.41,"10th_percentile":3415.41,"90th_percentile":3431.49,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":9431.75,"10th_percentile":9431.75,"90th_percentile":9431.75},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":12879.65,"10th_percentile":12879.65,"90th_percentile":12879.65,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":5374.89,"10th_percentile":5374.89,"90th_percentile":5374.89},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":970.32,"10th_percentile":970.32,"90th_percentile":970.32,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":9947.95,"10th_percentile":9947.95,"90th_percentile":9947.95,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":3336.39,"10th_percentile":3336.39,"90th_percentile":3336.39,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":4747.77,"10th_percentile":4747.77,"90th_percentile":4747.77,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":6071.0,"10th_percentile":6071.0,"90th_percentile":6071.0},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4511.36,"10th_percentile":4511.36,"90th_percentile":4511.36}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4219.55,"10th_percentile":4219.55,"90th_percentile":4219.55,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":36872.38,"10th_percentile":36872.38,"90th_percentile":36872.38,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":13264.73,"10th_percentile":13264.73,"90th_percentile":13264.73},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":11830.04,"10th_percentile":11830.04,"90th_percentile":11830.04},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2972.15,"10th_percentile":2972.15,"90th_percentile":2972.15,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":23.45,"10th_percentile":23.45,"90th_percentile":23.45,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":2217.22,"10th_percentile":1878.8,"90th_percentile":2478.63,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":969.67,"10th_percentile":969.67,"90th_percentile":969.67},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"14","median_amount":852.37,"10th_percentile":747.36,"90th_percentile":1037.2},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3592.03,"10th_percentile":993.53,"90th_percentile":4771.97},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":4948.34,"10th_percentile":4337.75,"90th_percentile":6019.17,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1629.67,"10th_percentile":1580.09,"90th_percentile":2973.13},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":2746.7,"10th_percentile":2746.7,"90th_percentile":4054.7,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2120.52,"10th_percentile":2120.52,"90th_percentile":2120.52},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1613.8,"10th_percentile":880.62,"90th_percentile":1703.65},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1715.4,"10th_percentile":598.82,"90th_percentile":13730.41},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":2597.24,"10th_percentile":2597.24,"90th_percentile":2597.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7982.54,"10th_percentile":7982.54,"90th_percentile":7982.54,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1759.87,"10th_percentile":1759.87,"90th_percentile":1759.87},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1647.38,"10th_percentile":1647.38,"90th_percentile":1647.38,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":2854.67,"10th_percentile":2854.67,"90th_percentile":2854.67},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":4573.39,"10th_percentile":4573.39,"90th_percentile":4883.68,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1374.69,"10th_percentile":1374.69,"90th_percentile":1374.69,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1780.69,"10th_percentile":1594.06,"90th_percentile":10468.57},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":5449.09,"10th_percentile":5449.09,"90th_percentile":5449.09,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1890.03,"10th_percentile":1760.12,"90th_percentile":10432.59},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":5891.9,"10th_percentile":5891.9,"90th_percentile":5891.9}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"15","median_amount":5868.27,"10th_percentile":5151.41,"90th_percentile":9581.99,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"14","median_amount":2241.48,"10th_percentile":1700.38,"90th_percentile":2996.17},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2246.32,"10th_percentile":2246.32,"90th_percentile":2465.68,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":1773.64,"10th_percentile":1773.64,"90th_percentile":3932.22},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":727.39,"10th_percentile":727.39,"90th_percentile":727.39,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"51","median_amount":5346.73,"10th_percentile":4122.12,"90th_percentile":9086.16,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2624.86,"10th_percentile":2271.9,"90th_percentile":3821.21},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1814.77,"10th_percentile":1810.13,"90th_percentile":5424.42,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":4616.61,"10th_percentile":4115.02,"90th_percentile":4810.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"40","median_amount":2367.72,"10th_percentile":1871.46,"90th_percentile":2920.8},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":2566.71,"10th_percentile":2566.71,"90th_percentile":2566.71},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":5636.9,"10th_percentile":5025.58,"90th_percentile":15326.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"31","median_amount":2142.34,"10th_percentile":1660.94,"90th_percentile":3871.83},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1707.41,"10th_percentile":1707.41,"90th_percentile":1707.41,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4145.83,"10th_percentile":4145.83,"90th_percentile":4145.83},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":9105.97,"10th_percentile":3723.66,"90th_percentile":11735.6,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3982.22,"10th_percentile":3982.22,"90th_percentile":3982.22},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":5361.49,"10th_percentile":5361.49,"90th_percentile":8193.27},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":12473.24,"10th_percentile":12473.24,"90th_percentile":12473.24,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":14383.19,"10th_percentile":14383.19,"90th_percentile":14383.19},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":22056.23,"10th_percentile":19749.91,"90th_percentile":35524.07,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":6529.77,"10th_percentile":6529.77,"90th_percentile":6529.77},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1256.64,"10th_percentile":1256.64,"90th_percentile":1256.64,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":16130.1,"10th_percentile":12014.33,"90th_percentile":19287.56,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":7047.2,"10th_percentile":7047.2,"90th_percentile":7047.2,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":7539.31,"10th_percentile":7539.31,"90th_percentile":7539.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":8846.94,"10th_percentile":7193.51,"90th_percentile":9212.96},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2740.89,"10th_percentile":2740.89,"90th_percentile":7643.96},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":122.75,"10th_percentile":82.35,"90th_percentile":125.89},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":127.89,"10th_percentile":49.82,"90th_percentile":215.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":331.93,"10th_percentile":331.93,"90th_percentile":331.93},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":253.52,"10th_percentile":253.52,"90th_percentile":253.52},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":314.42,"10th_percentile":314.42,"90th_percentile":314.42,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2762.18,"10th_percentile":2762.18,"90th_percentile":2762.18,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":8882.02,"10th_percentile":8882.02,"90th_percentile":8882.02,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":3011.84,"10th_percentile":3011.84,"90th_percentile":3011.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":269.21,"10th_percentile":269.21,"90th_percentile":269.21},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4083.65,"10th_percentile":4083.65,"90th_percentile":4083.65},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":7084.82,"10th_percentile":7084.82,"90th_percentile":7084.82,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":5838.49,"10th_percentile":5838.49,"90th_percentile":6459.98},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":10644.01,"10th_percentile":10644.01,"90th_percentile":10644.01,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4684.71,"10th_percentile":4684.71,"90th_percentile":4684.71},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":3830.78,"10th_percentile":3830.78,"90th_percentile":3830.78,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4529.62,"10th_percentile":4529.62,"90th_percentile":9132.72},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":14436.66,"10th_percentile":14436.66,"90th_percentile":14436.66},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":6554.2,"10th_percentile":6554.2,"90th_percentile":6554.2,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":29698.97,"10th_percentile":29698.97,"90th_percentile":29698.97,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":6405.15,"10th_percentile":6405.15,"90th_percentile":6405.15},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":13226.43,"10th_percentile":13226.43,"90th_percentile":38963.28,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":9668.79,"10th_percentile":9668.79,"90th_percentile":9668.79},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":8182.81,"10th_percentile":5394.26,"90th_percentile":15623.95},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":13201.59,"10th_percentile":13201.59,"90th_percentile":13201.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":8486.26,"10th_percentile":8486.26,"90th_percentile":8486.26},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":14708.42,"10th_percentile":14708.42,"90th_percentile":14708.42}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3612.28,"10th_percentile":3612.28,"90th_percentile":3612.28,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1212.49,"10th_percentile":1212.49,"90th_percentile":1212.49},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2082.8,"10th_percentile":382.0,"90th_percentile":2082.8},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":5875.83,"10th_percentile":1529.87,"90th_percentile":12461.46,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1291.46,"10th_percentile":920.79,"90th_percentile":3325.27},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":17.31,"10th_percentile":17.31,"90th_percentile":17.31,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":2836.15,"10th_percentile":2836.15,"90th_percentile":2836.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":288.74,"10th_percentile":288.74,"90th_percentile":1925.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"12","median_amount":2161.79,"10th_percentile":1277.42,"90th_percentile":2667.02},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2026.8,"10th_percentile":2026.8,"90th_percentile":2026.8,"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":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1027.23,"10th_percentile":1027.23,"90th_percentile":2474.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":6345.26,"10th_percentile":6345.26,"90th_percentile":6345.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"13","median_amount":1168.93,"10th_percentile":285.05,"90th_percentile":2337.37},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":2026.55,"10th_percentile":2026.55,"90th_percentile":2026.55,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":944.26,"10th_percentile":318.98,"90th_percentile":946.74,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":133.95,"10th_percentile":133.95,"90th_percentile":301.65},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":554.63,"10th_percentile":554.63,"90th_percentile":554.63,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":39.0,"10th_percentile":39.0,"90th_percentile":128.81,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":232.62,"10th_percentile":59.51,"90th_percentile":973.18,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":230.1,"10th_percentile":230.1,"90th_percentile":230.1},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":74.97,"10th_percentile":74.97,"90th_percentile":90.2,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":689.24,"10th_percentile":689.24,"90th_percentile":689.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":119.46,"10th_percentile":119.46,"90th_percentile":119.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"31","median_amount":191.94,"10th_percentile":40.0,"90th_percentile":267.11},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":270.83,"10th_percentile":270.83,"90th_percentile":270.83},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":271.31,"10th_percentile":271.31,"90th_percentile":271.31,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"23","median_amount":88.4,"10th_percentile":74.49,"90th_percentile":228.63},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":668.28,"10th_percentile":668.28,"90th_percentile":782.19,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":299.61,"10th_percentile":12.19,"90th_percentile":382.52},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":772.01,"10th_percentile":425.76,"90th_percentile":772.01,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":198.1,"10th_percentile":198.1,"90th_percentile":198.1,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":469.41,"10th_percentile":11.74,"90th_percentile":1835.72,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":749.98,"10th_percentile":749.98,"90th_percentile":749.98},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":7.61,"10th_percentile":7.61,"90th_percentile":7.61,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":570.07,"10th_percentile":554.7,"90th_percentile":1310.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":393.9,"10th_percentile":393.9,"90th_percentile":393.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"17","median_amount":304.61,"10th_percentile":103.49,"90th_percentile":419.6},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":244.17,"10th_percentile":244.17,"90th_percentile":244.17}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1097.94,"10th_percentile":743.18,"90th_percentile":1395.94,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":709.35,"10th_percentile":263.03,"90th_percentile":2321.28},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":531.93,"10th_percentile":531.93,"90th_percentile":531.93,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":199.93,"10th_percentile":199.93,"90th_percentile":199.93,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1013.43,"10th_percentile":1013.43,"90th_percentile":1013.43},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":102.35,"10th_percentile":102.35,"90th_percentile":317.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"29","median_amount":521.09,"10th_percentile":369.68,"90th_percentile":836.76},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":502.43,"10th_percentile":502.43,"90th_percentile":1060.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":0.25,"10th_percentile":0.25,"90th_percentile":0.25}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"75","median_amount":321.63,"10th_percentile":269.86,"90th_percentile":880.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":156.31,"10th_percentile":156.31,"90th_percentile":156.31},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"43","median_amount":32.31,"10th_percentile":22.29,"90th_percentile":132.56,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"170","median_amount":241.93,"10th_percentile":180.36,"90th_percentile":737.93,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"57","median_amount":96.53,"10th_percentile":74.83,"90th_percentile":257.12},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"58","median_amount":86.22,"10th_percentile":77.63,"90th_percentile":206.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"21","median_amount":274.57,"10th_percentile":109.27,"90th_percentile":1018.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"14","median_amount":89.11,"10th_percentile":53.78,"90th_percentile":200.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"173","median_amount":93.56,"10th_percentile":72.47,"90th_percentile":272.84},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"46","median_amount":264.6,"10th_percentile":180.4,"90th_percentile":975.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"12","median_amount":95.56,"10th_percentile":80.69,"90th_percentile":140.28}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"89","median_amount":749.14,"10th_percentile":513.98,"90th_percentile":1498.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"18","median_amount":412.55,"10th_percentile":174.38,"90th_percentile":824.06,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"80","median_amount":1967.7,"10th_percentile":577.3,"90th_percentile":2923.77,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"26","median_amount":738.39,"10th_percentile":238.18,"90th_percentile":921.83},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"13","median_amount":797.68,"10th_percentile":718.09,"90th_percentile":980.13,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":1717.5,"10th_percentile":1639.3,"90th_percentile":2886.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":812.77,"10th_percentile":221.47,"90th_percentile":1076.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"102","median_amount":779.83,"10th_percentile":242.73,"90th_percentile":1148.81},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":270.44,"10th_percentile":270.44,"90th_percentile":270.44},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"13","median_amount":2382.87,"10th_percentile":1536.1,"90th_percentile":2455.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"93","median_amount":746.17,"10th_percentile":242.73,"90th_percentile":1166.64},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"11","median_amount":833.97,"10th_percentile":224.05,"90th_percentile":1166.01,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":833.5,"10th_percentile":697.99,"90th_percentile":1573.64,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":774.34,"10th_percentile":755.34,"90th_percentile":802.11}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"30","median_amount":2018.65,"10th_percentile":1602.1,"90th_percentile":5203.55,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"42","median_amount":591.54,"10th_percentile":579.71,"90th_percentile":2295.13},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"11","median_amount":996.1,"10th_percentile":616.35,"90th_percentile":1278.84,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":1037.67,"10th_percentile":1037.67,"90th_percentile":1037.67},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"12","median_amount":207.28,"10th_percentile":207.28,"90th_percentile":540.03,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"83","median_amount":1606.04,"10th_percentile":640.33,"90th_percentile":3175.26,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"25","median_amount":659.42,"10th_percentile":628.02,"90th_percentile":2916.73},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":572.48,"10th_percentile":572.48,"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."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":2145.41,"10th_percentile":1338.37,"90th_percentile":2733.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":591.54,"10th_percentile":581.61,"90th_percentile":732.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"112","median_amount":630.62,"10th_percentile":510.84,"90th_percentile":2048.55},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"21","median_amount":2723.27,"10th_percentile":1366.32,"90th_percentile":3714.65,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"73","median_amount":640.84,"10th_percentile":512.67,"90th_percentile":1602.45},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":591.54,"10th_percentile":591.54,"90th_percentile":1569.16,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":920.56,"10th_percentile":705.59,"90th_percentile":1139.4,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":572.95,"10th_percentile":572.95,"90th_percentile":962.75}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":3050.84,"10th_percentile":2760.88,"90th_percentile":5481.14,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"21","median_amount":783.53,"10th_percentile":213.67,"90th_percentile":1082.02},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":272.34,"10th_percentile":269.36,"90th_percentile":874.9,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":295.18,"10th_percentile":11.0,"90th_percentile":2842.24,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"29","median_amount":2894.21,"10th_percentile":591.2,"90th_percentile":4892.03,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1213.03,"10th_percentile":592.98,"90th_percentile":2545.11},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":865.71,"10th_percentile":865.71,"90th_percentile":865.71,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":4304.83,"10th_percentile":4304.83,"90th_percentile":4304.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1080.0,"10th_percentile":736.57,"90th_percentile":1203.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"54","median_amount":1081.14,"10th_percentile":594.89,"90th_percentile":2603.38},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":3341.8,"10th_percentile":2520.23,"90th_percentile":4620.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"57","median_amount":1398.82,"10th_percentile":759.67,"90th_percentile":2450.05},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":1024.42,"10th_percentile":712.33,"90th_percentile":2099.14,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":643.64,"10th_percentile":222.46,"90th_percentile":3142.86}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"30","median_amount":3772.03,"10th_percentile":1250.05,"90th_percentile":4861.73,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"31","median_amount":1414.09,"10th_percentile":680.57,"90th_percentile":1603.0},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1101.96,"10th_percentile":272.34,"90th_percentile":1324.16,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":2183.03,"10th_percentile":2183.03,"90th_percentile":2183.03},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":333.26,"10th_percentile":44.61,"90th_percentile":661.39,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"58","median_amount":3200.54,"10th_percentile":951.55,"90th_percentile":4040.83,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"15","median_amount":1502.92,"10th_percentile":1228.15,"90th_percentile":1620.58},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1344.16,"10th_percentile":63.09,"90th_percentile":1700.27,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"11","median_amount":2800.39,"10th_percentile":2016.39,"90th_percentile":3273.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1412.81,"10th_percentile":1316.64,"90th_percentile":1988.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"69","median_amount":1343.0,"10th_percentile":771.54,"90th_percentile":1605.61},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"1 through 10","median_amount":1882.01,"10th_percentile":1882.01,"90th_percentile":1882.01},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"15","median_amount":1350.89,"10th_percentile":1169.29,"90th_percentile":1453.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"14","median_amount":4120.67,"10th_percentile":2903.79,"90th_percentile":4487.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"59","median_amount":1356.86,"10th_percentile":1087.63,"90th_percentile":1631.74},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":1386.32,"10th_percentile":1368.37,"90th_percentile":4494.18,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":309.28,"10th_percentile":129.34,"90th_percentile":1481.76,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1316.26,"10th_percentile":1316.26,"90th_percentile":1316.26}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"13","median_amount":1104.17,"10th_percentile":1004.82,"90th_percentile":1956.91},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1504.97,"10th_percentile":1504.97,"90th_percentile":1504.97,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":460.47,"10th_percentile":460.47,"90th_percentile":662.73,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3025.14,"10th_percentile":939.9,"90th_percentile":3751.62,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"12","median_amount":1194.64,"10th_percentile":1085.18,"90th_percentile":1266.17},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1734.75,"10th_percentile":1734.75,"90th_percentile":1734.75,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":7771.62,"10th_percentile":7771.62,"90th_percentile":7771.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1124.26,"10th_percentile":1124.26,"90th_percentile":1124.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"44","median_amount":1138.83,"10th_percentile":930.61,"90th_percentile":1535.08},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"26","median_amount":1148.02,"10th_percentile":875.47,"90th_percentile":1537.76},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":1124.26,"10th_percentile":1124.26,"90th_percentile":1161.26,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1373.45,"10th_percentile":1373.45,"90th_percentile":3161.76,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1090.92,"10th_percentile":1090.92,"90th_percentile":1090.92}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2383.69,"10th_percentile":2383.69,"90th_percentile":2383.69,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":348.67,"10th_percentile":348.67,"90th_percentile":348.67},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":598.26,"10th_percentile":598.26,"90th_percentile":598.26,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":432.62,"10th_percentile":432.62,"90th_percentile":432.62},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":689.13,"10th_percentile":689.13,"90th_percentile":689.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":427.1,"10th_percentile":427.1,"90th_percentile":427.1},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":525.44,"10th_percentile":525.44,"90th_percentile":525.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":2688.83,"10th_percentile":2688.83,"90th_percentile":2688.83,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1579.39,"10th_percentile":1579.39,"90th_percentile":1579.39},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":365.05,"10th_percentile":365.05,"90th_percentile":365.05,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":4016.11,"10th_percentile":4016.11,"90th_percentile":5595.08,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":1857.51,"10th_percentile":1857.51,"90th_percentile":1857.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":838.01,"10th_percentile":838.01,"90th_percentile":838.01},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1651.45,"10th_percentile":1651.45,"90th_percentile":1651.46},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":276.88,"10th_percentile":276.88,"90th_percentile":276.88,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":45.52,"10th_percentile":45.52,"90th_percentile":45.52},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":76.78,"10th_percentile":76.78,"90th_percentile":76.78,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":210.91,"10th_percentile":210.91,"90th_percentile":210.91},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":202.28,"10th_percentile":202.28,"90th_percentile":202.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":44.7,"10th_percentile":44.7,"90th_percentile":44.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":47.46,"10th_percentile":47.46,"90th_percentile":47.46},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":96.86,"10th_percentile":96.86,"90th_percentile":455.0},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":789.54,"10th_percentile":469.48,"90th_percentile":1824.19,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":416.35,"10th_percentile":416.35,"90th_percentile":416.35},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":11817.85,"10th_percentile":313.06,"90th_percentile":12869.11,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":9829.42,"10th_percentile":9829.42,"90th_percentile":9829.42,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":4258.59,"10th_percentile":4258.59,"90th_percentile":4258.59},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":2974.32,"10th_percentile":2974.32,"90th_percentile":2974.32,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1973.75,"10th_percentile":1973.75,"90th_percentile":1973.75},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":19974.14,"10th_percentile":19974.14,"90th_percentile":19974.14,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":5538.87,"10th_percentile":5538.87,"90th_percentile":5538.87},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":4207.97,"10th_percentile":4207.97,"90th_percentile":4207.97,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":7636.17,"10th_percentile":7636.17,"90th_percentile":7636.17},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":7067.95,"10th_percentile":6915.6,"90th_percentile":12304.85},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":8513.38,"10th_percentile":8513.38,"90th_percentile":8513.38},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":305.95,"10th_percentile":203.74,"90th_percentile":7095.27,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"66","median_amount":1799.99,"10th_percentile":52.37,"90th_percentile":4844.26},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":2585.32,"10th_percentile":2389.05,"90th_percentile":2667.94,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"27","median_amount":106.57,"10th_percentile":13.48,"90th_percentile":2568.75,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"45","median_amount":488.91,"10th_percentile":67.99,"90th_percentile":3653.02,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"32","median_amount":2250.43,"10th_percentile":65.21,"90th_percentile":2704.48},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"32","median_amount":465.03,"10th_percentile":436.17,"90th_percentile":788.42,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":931.85,"10th_percentile":931.85,"90th_percentile":931.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1432.1,"10th_percentile":1432.1,"90th_percentile":2232.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"100","median_amount":2317.6,"10th_percentile":75.51,"90th_percentile":3360.23},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"18","median_amount":765.46,"10th_percentile":89.0,"90th_percentile":2934.11,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":2186.79,"10th_percentile":2186.79,"90th_percentile":8375.13,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"91","median_amount":459.56,"10th_percentile":67.91,"90th_percentile":2980.84},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":28841.18,"10th_percentile":19288.58,"90th_percentile":28912.67,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":628.0,"10th_percentile":628.0,"90th_percentile":628.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":406.03,"10th_percentile":406.03,"90th_percentile":406.03}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"37","median_amount":646.26,"10th_percentile":94.0,"90th_percentile":2933.88,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"33","median_amount":2713.1,"10th_percentile":394.77,"90th_percentile":3295.7},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1457.64,"10th_percentile":812.26,"90th_percentile":2676.01,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1534.0,"10th_percentile":88.3,"90th_percentile":4021.12,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"52","median_amount":715.95,"10th_percentile":523.06,"90th_percentile":4739.23,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":585.7,"10th_percentile":556.93,"90th_percentile":6089.82},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"12","median_amount":6076.39,"10th_percentile":3973.14,"90th_percentile":7580.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":976.9,"10th_percentile":908.48,"90th_percentile":1477.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":582.04,"10th_percentile":582.04,"90th_percentile":582.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"109","median_amount":617.26,"10th_percentile":224.54,"90th_percentile":2302.5},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1833.77,"10th_percentile":1833.77,"90th_percentile":1833.77,"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":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"13","median_amount":345.36,"10th_percentile":195.28,"90th_percentile":3048.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1335.22,"10th_percentile":1335.22,"90th_percentile":2251.44,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"72","median_amount":573.16,"10th_percentile":188.84,"90th_percentile":2260.68},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"18","median_amount":1212.83,"10th_percentile":323.12,"90th_percentile":4893.06,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":1982.99,"10th_percentile":1982.99,"90th_percentile":1982.99,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2009.64,"10th_percentile":2009.64,"90th_percentile":4681.31}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"13","median_amount":5286.17,"10th_percentile":2898.79,"90th_percentile":7551.57,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"24","median_amount":7705.49,"10th_percentile":7515.67,"90th_percentile":9426.56},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":12653.21,"10th_percentile":2894.3,"90th_percentile":12948.1,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"48","median_amount":8378.05,"10th_percentile":5076.56,"90th_percentile":9498.27,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"55","median_amount":8444.75,"10th_percentile":5332.94,"90th_percentile":9489.14},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"25","median_amount":9310.24,"10th_percentile":1761.05,"90th_percentile":9531.02},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"13","median_amount":9692.74,"10th_percentile":1195.04,"90th_percentile":10783.94,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"15","median_amount":6589.44,"10th_percentile":5517.86,"90th_percentile":7319.47}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":570.98,"10th_percentile":570.98,"90th_percentile":570.98},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":877.64,"10th_percentile":877.64,"90th_percentile":877.64,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2511.31,"10th_percentile":2511.31,"90th_percentile":2511.31},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":1684.27,"10th_percentile":1684.27,"90th_percentile":1684.27,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":694.43,"10th_percentile":694.43,"90th_percentile":694.43},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":889.93,"10th_percentile":889.93,"90th_percentile":889.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1164.96,"10th_percentile":1164.96,"90th_percentile":1164.96},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1338.52,"10th_percentile":1338.52,"90th_percentile":1338.52,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":408.71,"10th_percentile":408.71,"90th_percentile":408.71,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":45.19,"10th_percentile":45.19,"90th_percentile":45.19,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"11","median_amount":1064.93,"10th_percentile":350.0,"90th_percentile":1064.93,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":416.43,"10th_percentile":416.43,"90th_percentile":416.43},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":379.6,"10th_percentile":379.6,"90th_percentile":379.6,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":887.44,"10th_percentile":887.44,"90th_percentile":887.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":404.11,"10th_percentile":295.5,"90th_percentile":424.93},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":424.93,"10th_percentile":424.93,"90th_percentile":3031.14},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":396.64,"10th_percentile":396.64,"90th_percentile":396.64,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":3719.0,"10th_percentile":3719.0,"90th_percentile":7827.08,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2374.82,"10th_percentile":2150.43,"90th_percentile":2418.07},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3106.8,"10th_percentile":750.0,"90th_percentile":5538.13,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2895.43,"10th_percentile":2895.43,"90th_percentile":2895.43},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1410.76,"10th_percentile":849.19,"90th_percentile":3601.8},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":3337.57,"10th_percentile":3337.57,"90th_percentile":3337.57,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1301.65,"10th_percentile":1156.94,"90th_percentile":2843.47},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":299.51,"10th_percentile":299.51,"90th_percentile":323.59,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":96.77,"10th_percentile":96.77,"90th_percentile":96.77},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":93.31,"10th_percentile":93.31,"90th_percentile":93.31,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":161.66,"10th_percentile":161.66,"90th_percentile":161.66},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":11.61,"10th_percentile":11.61,"90th_percentile":11.61,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":250.21,"10th_percentile":250.21,"90th_percentile":250.21,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":106.2,"10th_percentile":106.2,"90th_percentile":106.2},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":89.65,"10th_percentile":89.65,"90th_percentile":89.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":208.51,"10th_percentile":208.51,"90th_percentile":1286.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":98.34,"10th_percentile":98.24,"90th_percentile":107.86},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":90.9,"10th_percentile":90.9,"90th_percentile":90.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":299.26,"10th_percentile":299.26,"90th_percentile":299.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":99.84,"10th_percentile":79.87,"90th_percentile":107.86},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":326.13,"10th_percentile":326.13,"90th_percentile":326.13,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":167.26,"10th_percentile":167.26,"90th_percentile":232.5},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":104.56,"10th_percentile":104.56,"90th_percentile":104.56,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":1360.29,"10th_percentile":1360.29,"90th_percentile":1360.29},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":9.06,"10th_percentile":9.06,"90th_percentile":9.06,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":151.97,"10th_percentile":151.96,"90th_percentile":512.82,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":261.75,"10th_percentile":261.75,"90th_percentile":261.75},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":93.11,"10th_percentile":93.11,"90th_percentile":97.11,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":227.03,"10th_percentile":227.03,"90th_percentile":227.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":130.64,"10th_percentile":21.66,"90th_percentile":197.06},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":292.68,"10th_percentile":292.68,"90th_percentile":292.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":72.24,"10th_percentile":53.31,"90th_percentile":552.58},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":552.58,"10th_percentile":552.58,"90th_percentile":552.58,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":150.05,"10th_percentile":150.05,"90th_percentile":150.05,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":51.1,"10th_percentile":51.1,"90th_percentile":52.58}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1136.1,"10th_percentile":1136.1,"90th_percentile":1688.44,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":131.95,"10th_percentile":122.62,"90th_percentile":337.98},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":127.78,"10th_percentile":105.34,"90th_percentile":127.78,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":92.68,"10th_percentile":92.68,"90th_percentile":92.68,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"22","median_amount":524.36,"10th_percentile":267.16,"90th_percentile":853.37,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":574.9,"10th_percentile":132.84,"90th_percentile":586.53},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":645.7,"10th_percentile":645.7,"90th_percentile":645.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"35","median_amount":140.58,"10th_percentile":60.56,"90th_percentile":575.6},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":114.7,"10th_percentile":80.42,"90th_percentile":154.33,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":669.7,"10th_percentile":580.49,"90th_percentile":763.31,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"15","median_amount":209.23,"10th_percentile":132.84,"90th_percentile":586.53},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":128.76,"10th_percentile":122.62,"90th_percentile":550.54,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1668.92,"10th_percentile":1668.92,"90th_percentile":1668.92},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electronic Analysis of Devices","code_information":[{"code":"5743","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":141.71,"10th_percentile":141.71,"90th_percentile":141.71},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":189.28,"10th_percentile":189.28,"90th_percentile":189.28},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":6882.98,"10th_percentile":6882.98,"90th_percentile":6882.98,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":7738.7,"10th_percentile":7738.7,"90th_percentile":7738.7,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3153.57,"10th_percentile":3153.57,"90th_percentile":3153.57},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2119.03,"10th_percentile":1547.84,"90th_percentile":3128.02},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":7155.73,"10th_percentile":7155.73,"90th_percentile":7155.73,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2816.64,"10th_percentile":2816.64,"90th_percentile":3111.95},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":1466.57,"10th_percentile":1466.57,"90th_percentile":1466.57,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":907.41,"10th_percentile":907.41,"90th_percentile":907.41,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":59.99,"10th_percentile":59.99,"90th_percentile":59.99,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":1256.91,"10th_percentile":1256.91,"90th_percentile":1256.91,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":604.52,"10th_percentile":604.52,"90th_percentile":1090.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":806.6,"10th_percentile":806.6,"90th_percentile":806.6,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":1075.66,"10th_percentile":1075.66,"90th_percentile":1202.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":731.47,"10th_percentile":731.47,"90th_percentile":731.47},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":553.36,"10th_percentile":553.36,"90th_percentile":553.36,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Health and Behavior Services","code_information":[{"code":"5821","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":67.38,"10th_percentile":67.38,"90th_percentile":67.38,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":24.76,"10th_percentile":23.58,"90th_percentile":24.76,"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":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":133.0,"10th_percentile":133.0,"90th_percentile":133.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":9.88,"10th_percentile":9.88,"90th_percentile":9.88},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelet pheres leukoreduced","code_information":[{"code":"9501","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":2200.72,"10th_percentile":2200.72,"90th_percentile":2200.72},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":1014.26,"10th_percentile":1014.26,"90th_percentile":1014.26},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukoreduced irradiated","code_information":[{"code":"9522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":3437.4,"10th_percentile":3437.4,"90th_percentile":3437.4,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"30","median_amount":118.56,"10th_percentile":38.02,"90th_percentile":118.56,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"18","median_amount":38.02,"10th_percentile":36.2,"90th_percentile":43.15,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":63.99,"10th_percentile":63.99,"90th_percentile":63.99},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"32","median_amount":81.76,"10th_percentile":54.26,"90th_percentile":125.39,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"22","median_amount":34.28,"10th_percentile":31.31,"90th_percentile":35.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":111.72,"10th_percentile":111.72,"90th_percentile":111.72},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":34.28,"10th_percentile":34.28,"90th_percentile":34.28,"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":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"41","median_amount":30.28,"10th_percentile":29.3,"90th_percentile":34.28,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"26","median_amount":106.4,"10th_percentile":83.54,"90th_percentile":106.4,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":34.14,"10th_percentile":34.14,"90th_percentile":35.13,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"346","median_amount":332.6,"10th_percentile":100.17,"90th_percentile":886.74,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"330","median_amount":100.29,"10th_percentile":30.2,"90th_percentile":219.54},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"109","median_amount":61.24,"10th_percentile":18.33,"90th_percentile":218.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"706","median_amount":202.12,"10th_percentile":37.91,"90th_percentile":591.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"32","median_amount":138.58,"10th_percentile":67.46,"90th_percentile":347.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"11","median_amount":288.14,"10th_percentile":112.76,"90th_percentile":812.26}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"103","median_amount":458.56,"10th_percentile":458.56,"90th_percentile":481.5,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"83","median_amount":102.36,"10th_percentile":102.36,"90th_percentile":148.15},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":142.86,"10th_percentile":142.86,"90th_percentile":147.03,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":247.51,"10th_percentile":247.51,"90th_percentile":247.51},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":146.98,"10th_percentile":146.98,"90th_percentile":146.98,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"260","median_amount":383.08,"10th_percentile":358.97,"90th_percentile":383.1,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"41","median_amount":149.79,"10th_percentile":140.37,"90th_percentile":157.29},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"12","median_amount":136.55,"10th_percentile":132.67,"90th_percentile":143.38,"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":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"25","median_amount":319.23,"10th_percentile":319.14,"90th_percentile":319.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":141.1,"10th_percentile":141.1,"90th_percentile":148.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"170","median_amount":149.79,"10th_percentile":138.28,"90th_percentile":152.85},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":432.11,"10th_percentile":432.11,"90th_percentile":432.11},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"11","median_amount":132.57,"10th_percentile":128.81,"90th_percentile":139.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"52","median_amount":411.53,"10th_percentile":411.53,"90th_percentile":424.09,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"142","median_amount":161.64,"10th_percentile":161.64,"90th_percentile":164.33},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"1 through 10","median_amount":141.1,"10th_percentile":141.1,"90th_percentile":148.15,"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":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":142.68,"10th_percentile":142.68,"90th_percentile":264.06,"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 - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"11","median_amount":143.69,"10th_percentile":136.66,"90th_percentile":148.3}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"11","median_amount":308.11,"10th_percentile":293.44,"90th_percentile":482.12,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":416.86,"10th_percentile":416.86,"90th_percentile":416.86,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"1 through 10","median_amount":260.22,"10th_percentile":260.22,"90th_percentile":260.22},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":109.79,"10th_percentile":94.79,"90th_percentile":190.7,"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/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":1195.07,"10th_percentile":317.46,"90th_percentile":2798.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":150.74,"10th_percentile":150.74,"90th_percentile":177.16,"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/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"1 through 10","median_amount":335.62,"10th_percentile":335.62,"90th_percentile":335.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"1 through 10","median_amount":1553.48,"10th_percentile":1553.48,"90th_percentile":1553.48},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":527.43,"10th_percentile":139.38,"90th_percentile":901.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":263.34,"10th_percentile":263.34,"90th_percentile":263.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1501.53,"10th_percentile":1501.53,"90th_percentile":1501.53,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":118.19,"10th_percentile":118.19,"90th_percentile":118.19},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":14.98,"10th_percentile":14.98,"90th_percentile":14.98,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":123.16,"10th_percentile":123.16,"90th_percentile":123.16},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"21","median_amount":87.71,"10th_percentile":80.03,"90th_percentile":122.92},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":114.68,"10th_percentile":114.68,"90th_percentile":114.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"1 through 10","median_amount":340.52,"10th_percentile":340.52,"90th_percentile":340.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":0.31,"10th_percentile":0.29,"90th_percentile":4.97},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"1 through 10","median_amount":3.86,"10th_percentile":3.86,"90th_percentile":3.86}]}]},{"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 78] [Observation (%BC): 78] [Emergency Department (%BC): 78] [Occupational Therapy (%BC): 78] [Physical Therapy (%BC): 78] [Respiratory Services/Therapy  (%BC): 78] [Speech Therapy (%BC): 78] [Mental Health ($): 201] [Mental Health-Partial Hospitalization ($): 401] [All Other OP (%BC): 78]","count":"1 through 10","median_amount":1113.54,"10th_percentile":1113.54,"90th_percentile":1113.54,"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":"Aetna","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"AmeriHealth Caritas","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":126.45,"10th_percentile":126.45,"90th_percentile":126.45,"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":"Exchange","methodology":"percent of total billed charges","standard_charge_percentage":40.1,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Healthy Blue Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 62.06] [Observation (%BC): 62.06] [Emergency Department (%BC): 62.06] [Occupational Therapy (%BC): 62.06] [Physical Therapy (%BC): 62.06] [Respiratory Services/Therapy  (%BC): 62.06] [Speech Therapy (%BC): 62.06] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [Other Pharmacy (%): 34.29] [All Other OP (%BC): 62.06]","count":"1 through 10","median_amount":662.7,"10th_percentile":661.81,"90th_percentile":918.47,"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 - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carolina Complete Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":51.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"MedCost","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":62.65,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar Health Plan","plan_name":"Individual Health Plan HMO","methodology":"percent of total billed charges","standard_charge_percentage":61.13,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Partners Behavioral Health Management","plan_name":"Medicaid Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"1 through 10","median_amount":697.28,"10th_percentile":697.28,"90th_percentile":697.28,"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":"PHCS","plan_name":"PPO","methodology":"percent of total billed charges","standard_charge_percentage":90.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Community Plan Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers] [Mental Health ($): 512.18] [Mental Health-Intensive ($): 417.11]","count":"1 through 10","median_amount":425.21,"10th_percentile":425.21,"90th_percentile":425.21,"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":"HMO/PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 70] [Observation (%BC): 70] [Emergency Department ($): 940] [Occupational Therapy (%BC): 70] [Physical Therapy (%BC): 70] [Respiratory Services/Therapy  (%BC): 70] [Speech Therapy (%BC): 70] [All Other OP (%BC): 70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Optum VA CCN Government","methodology":"other","standard_charge_algorithm":"[All Services - Cost based: 101]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Vaya Health","plan_name":"Medicaid Managed Care - HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://medicaid.ncdhhs.gov/providers]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO","methodology":"percent of total billed charges","standard_charge_percentage":24.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]}]}